Published online Dec 24, 2019. doi: 10.5306/wjco.v10.i12.391
Peer-review started: March 8, 2019
First decision: April 16, 2019
Revised: October 10, 2019
Accepted: November 5, 2019
Article in press: November 5, 2019
Published online: December 24, 2019
Gynecological cancers still account for approximately 12% of all new cancer diagnoses in women and are often treated with platinum-based chemotherapy scheme. Cancer patients are often subjected to alterations in nutritional status due to both disease and treatment-related toxicities, especially gastrointestinal (GI) ones. Indeed impairment in nutritional status could worse patients’ quality of life (QoL), lead to treatments’ doses modifications and schedule delays and finally affect the overall prognosis.
The Mediterranean Diet (MD) model has already showed to assure a well-balanced food intake and potentially play an anti-inflammatory role. Moreover, several studies have already demonstrated a relationship between MD adherence and the prevention of cardiovascular and metabolic diseases and diabetes. More recently, Monteagudo and colleagues have validated the Mediterranean Diet Serving Score (MDSS) as an easy, valid, and accurate instrument to assess MD adherence[28]. Despite the recognized importance of prevent early onset of nutritional impairments in cancer patients assuring the maintenance of a good QoL and the relevance of gynecological cancers, few studies have explored the role of MD in preventing chemotherapy toxicities.
We aim to conduct an observational study to assess the role of MD in reducing GI toxicities in patients affected by gynecological cancers treated with chemotherapeutic platinum-based regimens according to their adherence to the MDSS.
We conducted an observational study on 24 patients with gynecological tumors treated with a platinum-based chemotherapy at Candiolo Cancer Institute (FPO-IRCCS) between January 2018 and June 2018. Patients affected by intestinal chronic disease or any other chronic condition, which could impact on GI toxicities were excluded from the study. Patients were interviewed at baseline by the food frequency questionnaire (FFQ) to evaluate food habits and intakes before the beginning of the chemotherapeutic treatment. FFQ was then administered each two cycles (up to three times for patients receiving 6 platinum-based cycles). Patients also received at each cycle the patients-reported outcome common terminology criteria for adverse events (PRO-CTCAE) questionnaire for GI toxicities assessment[29]. Furthermore, anthropometric assessments [weight; body mass index (BMI); basal energy expenditure; and total energy expenditure] were measured at each cycle.
Our study showed a trend toward lower GI toxicities in patients with high MDSS at each timepoint (first evaluation: P = 0.7; second: P = 0, 52; and third: P =0.01). Difference in nausea frequency and gravity (P < 0.001), stomachache frequency and gravity (P = 0.01 and P = 0.02), abdomen bloating frequency and gravity (P = 0.02 an P = 0.03), and interference with daily activities (P = 0.02) became highly statistically significant at the end of treatment. A higher reduction of food intake, both in terms of caloric (P = 0.29) and of single nutrients emerged in the group experienced higher toxicity. Of note, no significant changes in body weight and BMI were observed in our study population during treatment, even if more than 60% of patients declared to have changed their food habits during chemotherapy mainly because of GI toxicities.
Both FFQ and PRO-CTCAE results in our series suggest a protective role of MD in preventing cumulative GI chemotherapy induced toxic effects and supporting patients nutritional wellness during chemotherapy. However, our study also showed that about 50% of the patients declare to not receive sufficient information and nutritional advice before treatment, pawing the way for a better effort to assure patients high-quality comprehensive care.
This is the first observational study investigating the possible role of MD in preventing GI toxicities in gynecological cancer patients. Further studies with larger cohorts of patients might help to confirm if and how MD could impact on treatment related GI toxicities. The Italian Association of Medical Oncology (AIOM) has recently highlighted the importance for cancer patients to receive information from skilled professionals (i.e., dieticians, nutritionists, and medical oncologists), regarding the nutritional status, its possible changes during chemotherapy due to toxicities and the negative consequences. Future nutritional interventions should aim to prevent treatments’ side effects, assuring well-balanced nutritional status and QoL.